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Numeric analysis of heart rate variation in intrauterine growth-retarded fetuses: a longitudinal study
R J Snijders1, L S Ribbert, G H Visser
1Department of Obstetrics and Gynaecology, University Hospital Groningen, The Netherlands.
Insights
In fetuses with intrauterine growth retardation, a decrease in long-term fetal heart rate variation is a late indicator of impairment. This reduction coincides with the appearance of late decelerations, suggesting individual monitoring is key.
Area of Science:
- Perinatal medicine
- Fetal monitoring
- Obstetrics
Background:
- Intrauterine growth retardation (IUGR) poses risks to fetal well-being.
- Fetal heart rate (FHR) patterns are crucial for assessing fetal health.
- Late antepartum decelerations can indicate fetal distress.
Purpose of the Study:
- To investigate temporal changes in FHR and its variation in fetuses with IUGR.
- To correlate these changes with the development of late antepartum FHR decelerations.
Main Methods:
- Longitudinal study of 13 fetuses with IUGR over a median of 25 days.
- Serial one-hour FHR recordings (2-5 times/week) with numerical analysis.
- Maternal recording of fetal movements.
Main Results:
- Long-term FHR variation progressively decreased over time.
- FHR variation fell below 30 milliseconds concurrently with the onset of decelerations.
- A slight, significant increase in mean FHR was observed post-decelerations.
- Significant interfetal variability in all measured parameters.
Conclusions:
- Decreased long-term FHR variation is a late sign of fetal impairment in IUGR, coinciding with late decelerations.
- Individualized fetal surveillance, using each fetus as its own control, is recommended for IUGR management.
Objective:
We attempted to determine changes occurring with time in fetal heart rate and its variation in fetuses with intrauterine growth retardation in whom late antepartum fetal heart rate decelerations eventually develop.
Study Design:
Thirteen fetuses with intrauterine growth retardation were studied over a median period of 25 days. One-hour fetal heart rate records were made two to five times per week and were analyzed numerically. Fetal movements were recorded by the women.
Results:
On average long-term fetal heart rate variation decreased gradually with time and fell below the norm (30 milliseconds) at about the same time decelerations appeared. Mean heart rate showed a slight but statistically significant increase after the occurrence of decelerations. There were large interfetal differences in all parameters studied.
Conclusion:
In fetuses with intrauterine growth retardation a decrease in long-term fetal heart rate variation is a rather late sign of impairment that coincides with the occurrence of late decelerations. In the surveillance of the fetus with intrauterine growth retardation it might be most appropriate to use each fetus as its own control.